Introduction: This research addresses the intersecting epidemics of water insecurity, mental health, and healthcare engagement among women living with HIV in South Africa.
Method: Adult women (N = 164) living with HIV were administered surveys in English and isiXhosa to assess water insecurity, awareness of climate change, mental health, and healthcare engagement. ANOVA was used to estimate the association between water insecurity and mental health symptom severity while adjusting for sociodemographic characteristics. Key findings were compared across perinatal (n = 80) and non-perinatal (n = 84) groups.
Results: All were Black, primarily isiXhosa speaking, and receiving care at two publicly funded clinics near Cape Town. Mean age was 34 years (SD = 9.9). Participants were pregnant (33.5%), postpartum (25.6%), and breastfeeding (24.0%). Mean symptom severity was high across all mental health measures: depression (M = 27, SD= 21), anxiety (M = 9.5, SD= 5.8), climate anxiety (M = 17, SD= 12), and traumatic stress (M = 2.0, SD= 1.7). Water insecurity was high (M = 20, SD = 9.1) and predicted depression (F(1, 163) = 16.54, p < .001), anxiety (F(1, 163) = 14.61, p < .001), and climate anxiety (F(1, 163) = 9.97, p = .002), but not traumatic stress (F(1, 163) = .023, p = .880). Only water insecurity was significantly different, IWISE t(162) = -1.934, p =.044 for the perinatal group. Key dimensions of water insecurity for all participants were personal hygiene challenges and feelings of shame. Women reported that water insecurity negatively impacted attending medical(62.8%) and perinatal(67.7%) appointments, ART adherence(57.3%), perinatal care(44.2%), and taking medications(57.3%).
Conclusion: Water insecurity was associated with poor mental health and reduced healthcare engagement. Findings will advance a theory of water insecurity, HIV, and psychological distress, which is critical to improving maternal health outcomes for women living with HIV in climate-affected regions.